Preterm birth and previous conisation of the cervix


Author’s Reply


We thank PN Bamford and SA Hall1 for their interest in our article.2 The objective of our study was to evaluate the effect of conisation, mainly large loop excision of the transformation zone (LLETZ) procedures, on future obstetrical outcome. We did not evaluate the expectant management of cervical intraepithelial neoplasia (CIN). Conisation remains a risk factor for earlier delivery and smaller newborns. Whether this is caused by the procedure, or cervical disease and its related risk factors, remains unknown. Women should not undergo a conisation without clear indication, and the size of the cone must be kept minimal according to the size of the lesion. Expectant management of young women with abnormal cytology, but without obvious premalignant disease following colposcopy, with the majority of them having uncomplicated human papillomavirus (HPV)infections, remains important for every colposcopist, as conisations are not without risk.